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Dr. Stanley Biber

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Stanley Biber (1923–2006) was a surgeon in Trinidad during the twentieth century who specialized in sex reassignment surgeries. His clinic, one of the first in the country to offer sex reassignment surgeries, grew in reputation thanks to its compassionate treatment of transsexual patients. Biber’s life and work represent one piece of America’s evolving views on gender identity and sexuality, and his legacy remains that of a pioneering influence in medicine. Although Trinidad is no longer colloquially known as the “sex-change capitol of the world,” Biber’s practice indelibly shaped the history of that town and of a nationwide movement.

Early Life

Stanley Biber was born in Des Moines, Iowa. His parents recognized that they were rearing a talented child and hoped he would become a rabbi or a concert pianist. He briefly considered both options, but World War II intervened before he could decide on a career. During the war, Biber worked in Alaska as a member of the Office of Strategic Services (OSS), the intelligence and special operations organization that was the predecessor to the Central Intelligence Agency. After finishing his stint with the OSS, he returned to his home state and enrolled at the University of Iowa, where he graduated with a medical degree in 1948. In the middle of his studies, he found time to try out for the US Olympic weightlifting team, narrowly missing the cut.

Biber was eventually drawn to surgery, and during the Korean War, he headed a mobile army surgical hospital (MASH). The rigors of wartime medicine whetted his appetite for both helping people and challenging work. While stationed at Fort Carson, he learned that the United Mine Workers ofAmerica (UMW) was opening a clinic in Trinidad. In the early 1950s, the coal industry was prospering, but mining remained risky work. Biber may have seen working with miners as analogous to his wartime medical practice. His work soon extended beyond the UMW clinic, and his family quickly made a home in Trinidad. As a physician and the town’s only surgeon, he became familiar with many of the area’s residents in the course of performing appendectomies and removing gall bladders or tonsils. Biber’s office was in the First National Bank in Trinidad, the five-story sandstone landmark at Main and Commercial that prominently marks the historic heart of the city.

Fateful Request

Biber’s surgical practice took an unexpected turn in 1969, when a social worker friend asked if he would be willing to perform a sex reassignment surgery (SRS) for her. The social worker had been taking the hormone estrogen under the supervision of endocrinologist Dr. Harry Benjamin, one of the pioneers in transsexual research. Chemically, she had been living as a woman for some time. While not all transsexuals desired sex reassignment surgery, the social worker wanted Biber to shape female genitals out of her male genitals. Biber was unfamiliar with the surgical techniques of SRS, but he was intrigued and agreed to perform the surgery.

Biber later claimed that he had not even heard the term transsexual before his friend’s request. However, both the term and medical interest in changing the sex of people dated to the beginning of the twentieth century. From the nineteenth century until the mid-twentieth century, researchers referred to transsexual people as transvestites. Today, that term refers to people who elect to dress in the clothes of the opposite sex and is not usually associated with transsexual identity. In Europe, psychologists, surgeons, endocrinologists, and other researchers created the field of sexology, a broad discipline concerned with human sexual behavior that explores questions about the nature of sexual identity. Scholars in Germany and Austria pursued the possibility of using surgery and hormones to change a person’s gender and secondary sexual characteristics such as voice, the shape of mammary glands, or the presence of facial hair.

Brief Medical History of Transsexualism

In the 1920s, the German doctor Magnus Hirschfeld began performing SRS on men who wished to live as women. The first successful SRS was that of Dorchen Richter, who underwent a series of surgeries in the 1920s and 1930s at Hirschfeld’s institute in Berlin. The rise of Hitler and National Socialism caused Hirschfeld to flee Germany, and the Nazi government promptly destroyed his office and records. The German-trained doctor Harry Benjamin settled in the United States during World War I and was one of the few researchers pursuing questions associated with transsexuals during the first part of the twentieth century. He fell in with a loose group of sexual reformers—including Margaret Sanger, Alfred Kinsey, and Colorado’s own Benjamin Lindsey—who were interested in everything from contraceptives to liberalized divorce laws.

For transsexuals living in the United States, finding reputable medical care was basically impossible. Some people found doctors who would supervise hormone therapy, but Benjamin was one of the few endocrinologists sympathetic to the other struggles faced by transsexuals. Surgeons in Mexico and Morocco offered to do the surgery, but American surgeons remained reticent. The situation changed somewhat in 1966, when Johns Hopkins University began performing SRS, and the university could scarcely meet the immediate demand; during the first two years of the SRS clinic’s operation, more than 2,000 people requested the surgery.

Biber’s Career in SRS

In order to prepare for his friend’s surgery, Biber corresponded with surgeons at Johns Hopkins and used the hand-drawn notes that a surgeon sent him as a guide. Biber’s initial surgery was apparently a success, and word quickly spread that a doctor in Trinidad was not only willing to do SRS but was a good, thoughtful practitioner. This latter point was incredibly important, as people seeking SRS in the 1960s and 1970s could not be sure if their surgeon was a quack or running a so-called chop shop. Even when an individual found a competent, reputable surgeon, most patients had to endure the contempt of the doctors and hospital staff. By contrast, those who had surgery at Trinidad’s Mt. San Rafael Hospital reported a welcoming atmosphere.

As the number of patients seeking SRS from Biber steadily increased, he held a meeting with local religious leaders concerning the nature of the surgeries. Overall, the town’s reaction to his practice was muted. Most residents realized that SRS procedures were a great boon to the local economy. SRS was and remains incredibly expensive. Patients had to pay for their procedures in cash because no insurance plans covered SRS. This policy meant an influx of business not only for the hospital but also for the community, as patients and their supporters patronized local businesses during their stay in Trinidad.

Initially, the majority of Biber’s patients were men seeking surgical reassignment as women. Some psychologists speculated that there were simply more men who wanted the surgery than women. In recent years, it has become apparent that there are an equal number of women seeking the procedure and that for decades the high price tag of the surgery was prohibitive to many women. By the late 1970s, Biber and other surgeons offering SRS developed a protocol for diagnosing and treating transsexuals and ensuring responsible medical treatment. For instance, the standards of care require that SRS not be offered on demand. Before having surgery, a person must undergo several psychological evaluations and live as their desired gender for at least a year. Biber also interviewed his prospective clients before personally deciding whether or not to perform their surgeries.

The media quickly dubbed Trinidad the “sex-change capital of the world.” Some residents laughed off or embraced the label, while others protested that Trinidad’s history did not begin and end with Biber’s SRS procedures. In many media stories about Biber, reporters often failed to overcome their own misconceptions or preconceived notions about what sort of town would support a surgeon like Biber. Some reporters seemed to admire Biber and Trinidad—including Geraldo Rivera, who observed a surgery while researching a story for his patently sensationalist television program. Rivera appeared to be impressed by what he witnessed in Biber’s practice, describing the doctor as “a very amazing man” and “a Renaissance man.”

Later Career

In 1990 Biber ran for a seat on the Las Animas County Board of Commissioners that had been suddenly vacated following a recall election. In the midst of the election contest, some of Biber’s political rivals took out an advertisement in The TrinidadChronicle-News. In addition to taking issue with the doctor’s stance on various political issues, the ad took a swipe at the impact of the SRS procedures, asking the rhetorical question “over the past 20 years, what has his SPECIAL SURGERY on transsexuals done for the IMAGE of this community?” Biber smoothly responded with his own paid advertisement, which argued that his practice put Trinidad on the map for many Americans and that his patients “bring into the hospital coffers around $750,000 per year.” He concluded by praising the “intellectual tolerance exhibited by the people of Las Animas County to help me continue my work.” Biber won the seat by a comfortable margin.

By 2000, fewer people sought out Biber for SRS procedures. As an increasing number of compassionate surgeons around the nation began performing the procedure, it was no longer necessary to make the journey to Trinidad. Biber also cut back on the number of procedures he performed, taking time for his family, ranch, and other pursuits. When Biber retired in 2003, he estimated that he had performed over 5,000 SRS procedures during his career. He also made it clear that his retirement was, in part, forced upon him. His malpractice insurance carrier left Colorado in 2002, and the costs of insuring an eighty-year-old practicing surgeon were prohibitively high.

Biber’s pioneering efforts that made Trinidad an SRS center did not end with his retirement. Dr. Marci Bowers, formerly based in Seattle, came to Trinidad as an obstetrician and gynecologist in early 2003. Throughout the late 1990s and early 2000s, Mt. San Rafael Hospital had struggled to offer a full complement of services to local residents and for a time had closed its doors to obstetrics. Bowers joined a reinvigorated OB/GYN staff, and within the first two weeks of her arrival, she had delivered four babies. Later that year, Bowers extended her practice to include SRS procedures, guaranteeing that a steady stream of transsexual people would continue to make the journey to Trinidad. On January 16, 2006, at age eighty-two, Stanley Biber succumbed to pneumonia.